1 临床资料 患者,女,36岁,身高94 cm,体质量32 Kg,自幼常骨折儿童期诊断为成骨不全.患者系成骨不全III型,孕16周时第一次全市多学科讨论,心内科、呼吸科、骨科、产科、ICU等科室,综合评估患者心肺功能及对妊娠耐受,建议终止妊娠,患者及家属拒绝,22 周羊水穿刺:染色体非整倍体及基因组拷贝数变异,再次建议终止妊娠,患者及家属再次拒绝;23 周活动后出现胸闷、心累、气紧等不适,又再次建议终止妊娠,患者及家属坚决拒绝,要求继续妊娠,遂于我院门诊进行孕期监督,每2周产检1次.

背景:目前挤压驱血法广泛应用于全膝关节置换过程中.有研究表明,挤压驱血法有加重术后早期疼痛及增加术后并发症的风险,因此临床上急需一种能替代它的更加安全有效的驱血方法.目的:探讨全膝关节置换过程中使用抬腿驱血法和挤压驱血法对临床效果的影响.方法:将拟行初次单侧全膝关节置换的64例患者随机分为2组,置换过程中对照组采用挤压驱血,试验组采用抬腿驱血.术后比较2组患者的主要观察指标:目测类比评分、膝关节肿胀度、C-反应蛋白、血清肌酸激酶活性及术后并发症等;次要观察指标:止血带使用时间、美国特种外科医院评分、SF-36评分等.结果 与结论:①术后第1,7天及第1,3个月,试验组目测类比评分显著低于对照组(P＜0.05);②术后2组的C-反应蛋白水平、血清肌酸激酶活性及膝关节肿胀度均有升高,但试验组的升高程度明显低于对照组(P＜0.05);③在术后并发症方面,术后对照组在张力水泡及深静脉血栓发生率上高于试验组(P＜0.05),且对照组的总并发症发生率显著高于试验组(P＜0.05);④2组止血带的使用时间差异无显著性意义(P＞0.05);⑤随访第1,3,6个月评估美国特种外科医院评分及SF-36评分,结果显示较术前均有所改善,但组间比较差异无显著性意义(P＞0.05);⑥说明全膝关节置换过程中抬腿驱血可减轻术后早期疼痛反应,降低机体的炎症反应及患膝软组织损伤,减少皮肤张力性水泡、血栓栓塞等并发症的发生率,符合快速康复的理念要求.因此在全膝关节置换过程中抬腿驱血是一种比挤压驱血更加安全有效的驱血方法.

Objective To evaluate the influence of percutaneous endoscopic lumbar foraminoplasty of different facet joint portions on segmental range of motion (ROM) and intradiscal pressure (IDP) of L 3 /L 4 and L 4 /L 5 motion segments by establishing three dimensional finite element (FE) model. Method Computed tomography images of a male adult volunteer of appropriate age and in good condition both mentally and physically. Obtained data was used in this study from July 2020 to December 2020, and an intact L 3–5 three dimensional finite element model was successfully constructed using ANSYS and MIMICS software (model M1). The M1 was modified to simulate the foraminoplasty of different facet joint portions, with unilateral cylindrical excision (diameter = 0.75 cm) performed on the tip (model M2) and the base (model M3) of right L 5 superior facet elements along with surrounding capsular ligaments, respectively. Under the same loading conditions, the ROM and IDP of L 3 / 4 and L 4 /L 5 segments in states of forward flexion, backward extension, left lateral bending, right lateral bending, left axial rotation and right axial rotation were all compared. Result Compared with the intact model in backward extension, M2 increased the ROM of L 4/5 segment by 9.4% and IDP by 11.7%, while the ROM and IDP of M3 changed only slightly. In right axial rotation, M2 and M3 increased the ROM of L 4/5 segment by 17.9% and by 3.6%, respectively. In left axial rotation, M2 and M3 increased the ROM of L 4 /L 5 segment by 7.14% and 3.6%, respectively. As for other states including forward flexion, left lateral bending, right lateral bending, the ROM and IDP were not significantly distinct between these two models. While focusing on L 3 /L 4 segment, obviously changes in the ROM and IDP have not been presented and neither M2 nor M3 changed in any loading condition. Conclusion This study provides evidence that the base‐facet foraminoplasty of L 5 superior facet provided a higher segmental stability compared with the tip‐facet foraminoplasty in flexion and axial rotation. Meanwhile, it also shows the two types of foraminoplasty make few differences to the L 4/5 segmental biomechanics. Besides, it does not appear to impact the stability of L 3 /L 4 in six states of forward flexion, backward extension, left lateral bending, right lateral bending, left axial rotation and right axial rotation when superior facet of L 5 was partially removed. These findings might be useful in understanding biomechanics of the lumbar spine after foraminoplasty performed on different portions of the facet, thus providing endoscopic surgeons a better reference for operational approach to maintain the function and mobility of the spine.

Background: Chronic nonspecific low back pain (CNLBP) has become a major global public health problem. Its high incidence rate and high disability rate are so damaging both to individuals and communities. At present, many countries' clinical guidelines recommend exercise therapy. Breath therapy is one of the exercise therapies, playing an important role in exercise therapy. Some studies have shown that breath therapy has a considerable therapeutic effect on low back pain, but there is no specific conclusion. The aim of our study is to answer the question: if breath therapy is effective and safe for CNLBP? Methods: The following databases will be searched: English databases (including Web of Science, the Cochrane Library (Central), EMBASE, MEDLINE, Allied and Alternative Medicine) and Chinese databases (including Chinese National Knowledge Infrastructure, Wanfang data and Chinese Scientific Journals Database [VIP]). The literature search will be constructed around search terms for breath therapy, search terms for chronic nonspecific low back pain and search terms for randomized controlled trials. The primary outcomes were related to duration, intensity, attack frequency of pain, and the secondary outcomes were related to physical function, quality of life, and adverse events related to interventions. Endnote software 9.1 will be applied in selecting study, Review Manager software 5.3 will be applied in analyzing and synthesizing. Results: The results will provide evidence to judge whether breath therapy is effective and safe for CNLBP. Conclusion: Our research will provide reliable evidence of breath therapy for CNLBP. Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42020156340.

目的 探讨关节镜手术与非手术治疗踝关节退行性骨关节病的疗效比较.方法 选择我院患者98例踝关节退行性骨关节病患者,对照组:实施非手术治疗;观察组:实施手术治疗.结果 两组患者在治疗有效率方面进行比较,研究组97.96％与对照组的95.92％,不存在一定差异性,具有统计学意义(P＞0.05).两组患者在机体疼痛与踝关节功能评分方面进行对比,不存在较大差距,无统计学意义(P＞0.05).结论 综上所述:对关节镜手术与非手术方法对踝关节退行性骨关节病患者进行治疗均有一定效果,可调节踝关节功能,根据患者实际情况选择何种治疗方案,从而保证预后.

背景:关于全膝关节置换中止血带使用与否的术后效果对比已有报道,但鲜有文献明确提出限制性使用止血带和不使用止血带术后效果的差异.目的:观察全膝关节置换中限制性使用和不使用止血带对患者术后加速康复的影响.方法:随机选取2017年7月至2018年12月在成都中医药大学附属医院接受全膝关节置换治疗的患者90例,将患者随机分为3组:①限制使用止血带组:截骨完成后,仅于假体安装时应用止血带治疗,于膝关节假体成功放置且骨水泥硬化时结束;②后半程使用止血带组:截骨完成后,安装假体时开始使用止血带,直到切口缝合加压包扎;③不使用止血带组:全程不使用止血带,每组各30例.各组患者皆采用同样的围术期处理及加速康复训练,比较3组患者术后静脉血血红蛋白水平、C-反应蛋白水平、目测类比及HSS评分变化.结果与结论:①与限制性使用组和不使用止血带组比较,后半程使用止血带组术后1,3 d的膝关节疼痛目测类比评分和静脉血C-反应蛋白水平及术后1 d血红蛋白水平升高(P<0.05),术后3,7 d膝关节HSS评分降低(P<0.05);②术后限制使用止血带组和不使用止血带组的目测类比评分、HSS评分、C-反应蛋白及血红蛋白水平无显著差异;③结果证实,限制性使用止血带与不使用止血带对全膝关节置换后早期康复效果无明显差异,全膝关节置换后半程使用止血带会加重术后早期疼痛.

Two types(A model and B model) of articular cartilage defect models were prepared by using adult New Zealand white rabbits. A model group was applied by drilling without through subchondral bone, whose right joint was repaired by composite scaffolds made by seed cell, gum-bletilla as well as Pluronic F-127, and left side was blank control. B model group was applied by subchondral drilling method, whose right joint was repaired by using composite scaffolds made by gum-bletilla and Pluronic F-127 without seed cells, and left side was blank control. Autogenous contrast was used in both model types. In addition, another group was applied with B model type rabbits, which was repaired with artificial complex material of Pluronic F-127 in both joint sides. 4, 12 and 24 weeks after operation, the animals were sacrificed and the samples were collected from repaired area for staining with HE, typeⅡcollagen immunohistochemical method, Alcian blue, and toluidine blue, and then were observed with optical microscope. Semi-quantitative scores were graded by referring to Wakitanis histological scoring standard to investigate the histomorphology of repaired tissue. Hyaline cartilage repairing was achieved in both Group A and Group B, with satisfactory results. There were no significant differences on repairing effects for articular cartilage defects between composite scaffolds made by seed cell, gum-bletilla and Pluronic F-127, and the composite scaffolds made by gum-bletilla and Pluronic F-127 without seed cell. Better repairing effects for articular cartilage defects were observed in groups with use of gum-bletilla, indicating that gum-bletilla is a vital part in composite scaffolds material.

目的 研究老年全髋关节置换术治疗前后血清C反应蛋白(CRP)、红细胞沉降率(ESR)水平与术后认知功能的相关性.方法 抽取2016年2月至2018年1月成都中医药大学附属医院骨科接受全髋关节置换术的60例老年患者,其中术后未发生认知功能障碍(post-operative cognitive dysfunction,POCD)者42例,为对照组;发生POCD者18例,为试验组.所有患者分别于术前、术后接受静脉采血,检测血清CRP、ESR水平,记录CRP、ESR峰值异常率,并采用Logistic回归分析术后POCD与CRP、ESR水平的关系.结果 术前、术后6h、1、3、7d试验组血清CRP、ESR水平均明显高于对照组(P＜0.05).与对照组相比,试验组血清CRP、ESR峰值异常率均较高,差异有统计学意义(P＜0.05).Logistic回归分析显示,术前、术后ld血清CRP、ESR水平是POCD的影响因素(P＜0.05).结论 血清CRP、ESR水平升高可能增加老年全髋关节置换术后POCD发生风险,术前术后检测血清CRP、ESR水平有助于预测其风险.

目的 探讨应用空心螺钉联合微型钢板治疗后交叉韧带胫骨止点撕脱性骨折的临床疗效.方法 选取2017年3月至2018年3月成都中医药大学附属医院骨科收治的后交叉韧带胫骨撕脱骨折患者50例为研究对象,按照随机数字表法分为试验组和对照组,每组25例.两组患者术中均采用膝后内侧小切口入路,试验组患者采用空心螺钉联合微型钢板固定,对照组患者采用单纯空心螺钉固定,术后均随访.比较两组患者手术时间、术中出血量、手术并发症发生情况、骨折愈合时间以及患肢膝关节屈伸活动度;末次随访时用Lysholm评分系统对两组患者患膝关节功能进行评价.结果 试验组患者手术时间多于对照组,差异有统计学意义(P<0.05);试验组患者术中出血量与对照组患者比较,差异无统计学意义(P>0.05);试验组患者手术并发症发生率、骨折愈合时间明显低于对照组,差异有统计学意义(P<0.05);试验组患者末次随访时患膝关节活动度及患膝关节功能的Lysholm评分均高于对照组,差异有统计学意义(P<0.05).结论 空心螺钉联合微型钢板固定后交叉韧带胫骨止点撕脱骨折牢固可靠,术后恢复快,膝关节功能恢复满意,其是治疗膝关节后交叉韧带胫骨止点撕脱骨折安全有效的方法.

Objective:To observe the clinical efficacy and long-term efficacy of pestle needle in treating lumbago and leg pain due to Qi-stagnation and blood stasis.Methods:64 patients were randomly divided into two groups,32 in each group.The treatment group was treated by pestle needle combined with local Kerotherapy,the control group were treated by acupuncture combined with local Kerotherapy,5 days a course with an interval of 2 days between two courses,a total of 4 courses.At the end of treatment and the first,third,sixth months after the treatment,the efficacy was evaluated by the diagnostic criteria of TCM syndrome,visual analogue scale (VAS) and modified Japanese Society of Department of orthopedics low back pain score (M-JOA).Results:At the end of treatment,the total effective rate,VAS and M-JOA evaluation in the treatment group were superior to those in the control group (P ＜0.05).After the six-month follow-up,the efficacy of the treatment group was superior to that of the control group (P ＜ 0.05) Conclusion:The effect of pestle needle on lumbago and leg pain due to Qi-stagnation and blood stasis is definite,and it has certain persistence.

目的:观察加味当归四逆汤内服配合中药熨烫治疗膝骨性关节炎的临床疗效.方法:将120例膝骨性关节炎患者采用随机数字表法分为两组各60例.治疗组采用口服加味当归四逆汤配合中药熨烫治疗,对照组服用塞来昔布胶囊.两组均以1周为1疗程,治疗4个疗程后进行疗效比较.结果:治疗组总有效率为95.0％,对照组为88.3％,两组比较差异有显著性意义(P＜0.05).结论:加味当归四逆汤配合中药熨烫可缓解膝关节疼痛,改善膝关节功能.

C17H14FeN4, monoclinic, P21/c, a = 11.8213(11) Å, b = 10.3610(10) Å, c = 11.8552(11) Å, α = γ = 90°, β = 101.1540(10)°, V = 1424.6(2) Å3, Z = 4, Rgt(F) = 0.0233, wRref(F2) = 0.0653, T = 296(2) K.

Abstract C38H45ClN4OPd, trigonal, R3m, a = 30.1968(8) Å, b = 30.1968(8) Å, c = 11.4611(3) Å, α = β = 90°, γ = 120.00°, V = 9050.7(4) Å3, Z = 9, R gt (F) = 0.0397, wR ref (F 2 ) = 0.1053, T = 291.15 K.

Objective To compare the early efficacy of two different ways of rehabilitation exercises in total knee arthroplasty (TKA) patients. Method From January 2011 to January 2014,136 patients having undergone TKA were randomly divided into two groups. In group A , patients exercised under the guidance with doctor. In group B, patients exercised by using continuous passive movement (CPM) machine. Compared the data from the two groups including range of motion (ROM) of the knee joint, knee function score (KFS) and circumference of the knee joint, t test of independent sample was utilized in the research. Results All patientswere followed up in 4 weeks. The ROM and KFS of Group A was significantly better than Group B (P < 0.05). The knee circumference had no statistically significant difference between two groups (P> 0.05).Conclusion Group A and B are effective methods in TKA patients in early rehabilitation training. But training under the guidance of doctor has greater advantages than CPM.

目的:评价加味通督活血汤配合椎管减压联合Dynesys系统治疗退行性腰椎管狭窄症的临床疗效.方法:2010年1月～2013年12月,对35例退行性腰椎管狭窄的患者进行口服加味通督活血汤配合后路减压联合Dynesys系统置入,并进行临床随访,通过VAS和ODI评分评估临床疗效.结果:28名患者得到满意随访,随访12～35个月(平均22.8个月),VAS腰痛评分:术前6.5±1.5,术后2.2±1.1;VAS腿痛评分:术前7.8±1.6,术后2.8±1.5.ODI评分:术前(67.5±18.2)％,术后(21.5±12.3)％.参照Nakai标准:优18例;良7例;可3例;差0例,优良率达89.3％.结论:加味通督活血汤配合椎管减压联合Dynesys系统治疗退行性腰椎管狭窄症可获得满意的临床疗效,值得临床广泛推广.

目的分析膝关节内侧副韧带损伤的临床治疗方法及效果。方法搜集2012年7月~2013年7月我院膝关节内侧副韧带损伤76例，按照治疗方式不同将其分两组。给予实验组半肌腱解剖重建治疗，共38例；给予对照组内侧副韧带修复治疗，共38例。观察比较两组效果。结果与对照组相比，实验组膝关节功能评分改善情况较好(<0.05)，优良率高(<0.05)，差异显著。结论膝关节内侧副韧带损伤采用半肌腱解剖重建治疗，疗效佳，优良率较高，值得推广。

目的:评价股骨近端防旋髓内钉(PFNA)与动力髋螺钉(DHS)治疗稳定型股骨粗隆间骨折的临床疗效.方法:将在我院治疗的稳定型股骨粗隆间骨折患者分为PFNA治疗组24例和DHS治疗组24例,观察并比较两组患者的手术时间、术中出血量、引流量及术后髋部疼痛VAS评分及 Harris髋关节功能评分、术后并发症.结果:43例患者术后获得随访,随访时间6个月～20个月.两组患者在手术时间、术中出血量、引流量、及术后不同时间点髋部疼痛VAS评分及Harris髋关节功能评分差异均无统计学意义(P＞0.05).PFNA组治疗过程中发生l例深静脉血栓形成及1例肺栓塞.结论:对于稳定型股骨转子间骨折,PFNA与DHS均可获得良好的临床疗效,但PFNA并发症相对较多.

笔者于2015-02诊治股骨粗隆间骨折股骨近端防旋髓内钉(PFNA)内固定术后主钉断裂l例,报道如下. 病历摘要: 患者,女,76岁.因“摔伤致右髋关节疼痛伴右下肢活动受限2+月.”于2015-02-28由门诊收入我科.患者7+月前不慎摔伤致右股骨粗隆间骨折在外院行切开复位PFNA术,术后卧床1周后扶双拐下地行走,2月前患者乘车时不慎摔伤,即感右大腿内侧疼痛,伴右下肢活动受限,无右下肢肢端感觉、血运障碍,遂至成都骨科医院就诊,摄片示:右侧股骨上段骨折内固定术后,目前断端间少量骨痂形成,股骨内固定物断裂.予以输液(具体药物不详)治疗后患者疼痛症状缓解.

目的:评价加味当归四逆汤配合温针灸治疗膝关节炎(Osteoarthritis,OA)患者的临床疗效.方法:将95例膝骨性关节炎(OA)患者随机分为治疗组48例和对照组47例.治疗组服用加味当归四逆汤并配合温针灸治疗,对照组服用塞来昔布胶囊(西乐葆).2组均以1 w为1个疗程,治疗4个疗程后进行疗效评价及比较.结果:经过治疗后,总有效率:治疗组(95.8％),对照组(89.3％),2组比较有明显差异,具有统计学意义(P＜0.05),且2组在观察期间各项实验室检测指标均基本正常,未出现不良反应.结论:治疗组能明显缓解膝关节痛,改善膝关节功能,安全性好,无明显毒副作用.

目的报告并探讨膝关节脱位伴腘动脉超限时损伤的诊治。方法回顾2015年2月四川省中医院收治膝关节脱位伴腘动脉损伤病例1例，患者入院后进行常规检查，患者均得到确诊，分析患者膝关节脱位伴腘动脉超限时损伤的原因及其治疗方法，为临床膝关节脱位伴腘动脉超限时损伤治疗提供依据。结果经大隐静脉移植修复术+小腿筋膜间隔切开减压术+外固定支架固定术治疗后患肢保全。结论膝关节脱位伴腘动脉超限时损伤诊治难度大，截肢率高，患者发病后应该立即进行大隐静脉移植修复术+小腿筋膜间隔切开减压术+外固定支架固定术治疗，并对患者进行早期正确处理，降低截肢发生率。